Cha Jung-Joon, Lee Jae-Hwan, Ko Young-Guk, Roh Jae-Hyung, Yoon Yong-Hoon, Lee Yong-Joon, Lee Seung-Jun, Hong Sung-Jin, Ahn Chul-Min, Kim Jung-Sun, Kim Byeong-Keuk, Choi Donghoon, Hong Myeong-Ki, Jang Yangsoo
Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea.
Korean Circ J. 2022 Feb;52(2):123-133. doi: 10.4070/kcj.2021.0246. Epub 2021 Oct 28.
Atherectomy as a pretreatment has the potential to improve the outcomes of drug-coated balloon (DCB) treatment by reducing and modifying atherosclerotic plaques. The present study investigated the outcomes of atherectomy plus DCB (A+DCB) compared with DCB alone for the treatment of femoropopliteal artery disease.
A total of 311 patients (348 limbs) underwent endovascular therapy using DCB for native femoropopliteal artery lesions at two endovascular centers. Of these, 82 limbs were treated with A+DCB and 266 limbs with DCB alone. After propensity score matching based on clinical and lesion characteristics, a total of 82 pairs was compared for immediate and mid-term outcomes.
For the matched study groups, the lesion length was 172.7±111.2 mm, and severe calcification was observed in 43.3%. The technical success rate was higher in the A+DCB group than in the DCB group (80.5% vs. 62.2%, p=0.015). However, the A+DCB group showed more procedure-related minor complications (37.0% vs. 13.4%, p=0.047). At 2-year follow-up, primary clinical patency (73.8% vs. 82.6%, p=0.158) and the target lesion revascularization (TLR)-free survival (84.3% vs. 88.2%, p=0.261) did not differ between the two groups. In Cox proportional hazard analysis, atherectomy showed no significant impact on the outcome of DCB treatments.
The pretreatment with atherectomy improved technical success of DCB treatment; however, it was associated with increased minor complications. In this study, A+DCB showed no clinical benefit in terms of TLR-free survival or clinical patency compared with DCB treatment alone.
斑块旋切术作为一种预处理手段，有潜力通过减少和重塑动脉粥样硬化斑块来改善药物涂层球囊（DCB）治疗的效果。本研究调查了斑块旋切术联合DCB（A+DCB）与单纯DCB治疗股腘动脉疾病的效果。
在两个血管腔内治疗中心，共有311例患者（348条肢体）接受了DCB治疗原发性股腘动脉病变的血管腔内治疗。其中，82条肢体接受了A+DCB治疗，266条肢体仅接受了DCB治疗。根据临床和病变特征进行倾向评分匹配后，共比较了82对患者的即刻和中期结果。
对于匹配的研究组，病变长度为172.7±111.2mm，43.3%观察到严重钙化。A+DCB组的技术成功率高于DCB组（80.5%对62.2%，p=0.015）。然而，A+DCB组显示出更多与手术相关的轻微并发症（37.0%对13.4%，p=0.047）。在2年随访时，两组之间的主要临床通畅率（73.8%对82.6%，p=0.158）和无靶病变血管重建（TLR）生存率（84.3%对88.2%，p=0.261）并无差异。在Cox比例风险分析中，斑块旋切术对DCB治疗的结果无显著影响。
斑块旋切术预处理提高了DCB治疗的技术成功率；然而，它与更多轻微并发症相关。在本研究中，与单纯DCB治疗相比，A+DCB在无TLR生存率或临床通畅率方面未显示出临床益处。
